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Risk Factors for Suboptimal Medication Adherence in Persons With Multiple Sclerosis: Development of an Electronic Health Record-Based Explanatory Model for Disease-Modifying Therapy Use

  • Elizabeth S. Gromisch
    Correspondence
    Corresponding author Elizabeth S. Gromisch, PhD, 490 Blue Hills Ave, Hartford, CT 06112.
    Affiliations
    Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, Connecticut

    Psychology Service, VA Connecticut Healthcare System, West Haven, Connecticut

    Department of Neurology, University of Connecticut School of Medicine, Farmington, Connecticut

    Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut

    Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, Connecticut
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  • Aaron P. Turner
    Affiliations
    Multiple Sclerosis Center of Excellence West, Veterans Affairs, Seattle, Washington

    Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, Washington

    Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
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  • Steven L. Leipertz
    Affiliations
    Multiple Sclerosis Center of Excellence West, Veterans Affairs, Seattle, Washington
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  • John Beauvais
    Affiliations
    Psychology Service, VA Connecticut Healthcare System, West Haven, Connecticut

    Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
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  • Jodie K. Haselkorn
    Affiliations
    Multiple Sclerosis Center of Excellence West, Veterans Affairs, Seattle, Washington

    Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, Washington

    Department of Rehabilitation Medicine, University of Washington, Seattle, Washington

    Department of Epidemiology, University of Washington, Seattle, Washington
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Published:December 03, 2019DOI:https://doi.org/10.1016/j.apmr.2019.11.005

      Highlights

      • Less than 70% refilled their medications at least 80% of the time over 2 years.
      • Missed appointments, mood disorders, and traumatic brain injuries are among the risk factors.
      • There is an urgent need for interventions aimed at person-level barriers.
      • Disease-modifying therapy adherence should be discussed at every visit, whether it is multiple sclerosis–related or not.

      Abstract

      Objective

      To determine which factors are associated with suboptimal disease-modifying therapy (DMT) adherence and to develop an explanatory model that could be used to identify individuals at risk and potentially inform interventions.

      Design

      Cross-sectional cohort study using electronic health records.

      Setting

      Veterans Health Administration (VA).

      Participants

      Veterans with multiple sclerosis (MS) (N=2939; 79.69% men) who received care through the VA and were included in the VA MS Center of Excellence Data Repository.

      Interventions

      Not applicable.

      Main Outcome Measures

      Suboptimal DMT adherence (<80%), demographics, co-occurring conditions, and health care use.

      Results

      Nearly 31% of participants had suboptimal adherence. Flags for suboptimal adherence included >20% missed appointments (odds ratio [OR], 3.78; 95% CI, 2.45-2.82), traumatic brain injuries (OR, 1.55; 95% CI, 1.12-2.14), age younger than 59 years (OR, 1.47; 95% CI, 1.23-1.74), ≥1 emergency department visits (OR, 1.40; 95% CI, 1.18-1.67), mood disorders (ie, depressive and bipolar disorders) (OR, 1.40; 95% CI, 1.18-1.66), and service connection (OR, 1.22; 95% CI, 1.01-1.47). Hyperlipidemia (OR, 0.77; 95% CI, 0.65-0.92) and being issued a wheelchair (OR, 0.83; 95% CI, 0.70-1.00) were associated with lower risk.

      Conclusions

      Suboptimal adherence to DMTs continues to be an issue. Interventions that focus on person-level barriers should be urgently explored to increase adherence and improve self-management abilities.

      Keywords

      List of abbreviations:

      DMT (disease-modifying therapy), EHR (electronic health record), ED (emergency department), ICD (International Statistical Classification of Diseases and Related Health Problems), MS (multiple sclerosis), OR (odds ratio), TBI (traumatic brain injury), VA (Veterans Health Administration)
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